Natural mucosal barriers and COVID-19 in children

• DOI: 10.1172/jci.insight.148694
• Publication Date: 2021-04-06T16:05:50Z
• Authors: Carl A. Pierce; Sharlene Sy; Benjamin Galen; Doctor Y. Goldstein; Erika Orner; Marla J. Keller; Kevan C. Herold; Betsy C. Herold
• Keywords: 2019-20 coronavirus outbreak; Pandemic

BACKGROUNDCoronavirus disease 2019 (COVID-19) is more benign in children compared with adults for unknown reasons. This contrasts other respiratory viruses where manifestations are often severe children. We hypothesize that a robust early innate immune response to SARS coronavirus 2 (SARS-CoV-2) protects against disease.METHODSClinical outcomes, SARS-CoV-2 viral copies, and cellular gene expression were nasopharyngeal swabs obtained at the time of presentation emergency department from 12 27 using bulk RNA sequencing quantitative reverse-transcription PCR. Total protein, cytokines, anti-SARS-CoV-2 IgG IgA quantified nasal fluid.RESULTSSARS-CoV-2 angiotensin-converting enzyme 2, TMPRSS2 similar adults, but displayed higher genes associated IFN signaling, NLRP3 inflammasome, pathways. Higher levels IFN-α2, IFN-γ, IP-10, IL-8, IL-1β protein detected fluid versus adults. Children also expressed cells, whereas those epithelial cells did not differ Anti-SARS-CoV-2 both groups. None required supplemental oxygen, 7 (P = 0.03); 4 died.CONCLUSIONThese findings provide direct evidence vigorous mucosal suggest this contributes favorable clinical outcomes.FUNDINGNIH grants R01 AI134367, UL1 TR002556, T32 AI007501, T32GM007288, P30 AI124414; an Albert Einstein College Medicine Dean's COVID-19 Pilot Research Award; Eric J. Heyer, MD, PhD Translational Project Award.